Tattoo, Piercing And Breast Implantation Infections

16th European Congress of Clinical Microbiology and Infectious Diseases

Nice, France - In the USA, Canada, Australia and Northern Europe, between 8 and 13% of the population has tattoos and/or piercings, Jean-Baptiste Guiard-Schmid of the Paris Rothschild Hospital reported during the 16th European Congress of Clinical Microbiology and Infectious Disease (ECCMID). The congress, which is organized by the European Society of Clinical Microbiology and Infectious Disease (ESCMID), is currently underway in Nice and ends today.

In the USA alone, according to figures gathered in 2000, some 7 to 20 million Americans have tattoos, Guiard-Schmid said. Those with tattoos and piercings spanned various age and socio-economic groups. While piercings are more commonly found among teenagers; tattoos appear to be more popular with adults between the ages of 18 and 30. Other more extreme body modifications (scarification, foreign body implants, branding) are performed by a limited number of practitioners.

The main health complications associated with piercing and tattooing include infections, pathologic healing, allergic reactions, tissue damages, bleeding and odonto-stomatologic lesions.

Local bacterial infections are rare after tattooing but develop frequently from piercings, although they are usually minor. Between 10 to 20% of piercings are associated with local benign bacterial infection, according to the results of the few available studies on the topic. Typical symptoms of a local bacterial infection are redness, swelling, fever and pain. The main pathogens causing local infections, e.g. suppuration or abscesses, are Staphylococcus aureus, group A streptococcus and Pseudomonas spp. Impetigo has also been identified and is caused by Streptococcus pyogenes.

These infections may become chronic and lead to local pyogenic granuloma (also called botryomycoma). Bacterial infections occurring as a result of piercing rarely spread and rarely lead to severe or life-threatening infections. Erysipelas and cellulitis have been observed with S. aureus and S. pyogenes aetiology. Anecdotal case reports of leprosy, tuberculosis, syphilis, chancroid and tetanus have also been published in recent years.

The use of unsterilized needles, needle bars and tubes, forceps, jewelery, scalpels, dermographs and contaminated pigments can result in blood-borne infections, such as hepatitis B, C and HIV infection. HBV and HCV transmission have been well documented in cases reported about Dutch piercing shops in 1997 and in London tattooist shops during the late seventies. Similarly acute hepatitis C apparently originated from tattooing in an Australian prison population in 2001.

These viral infections may be asymptomatic in their early phases and therefore rarely diagnosed. Thus, their relationship to body modifications is not always realized. Piercing and tattooing are identified as risk factors for viral hepatitis in more than 20 epidemiological studies currently available. But debate continues among some authors who think that it is difficult to distinguish body modifications from other risk factors (use of intravenous drugs, incarceration, etc.) in the studied populations. Even if hepatitis B and C virus transmission rates are very low, the number of body modifications performed each year probably accounts for a significant number of hepatitis cases. Fortunately, the HBV vaccination should prevent at least half of these cases. HIV transmission has been documented by a case reported in 1997. The patient had been contaminated in a period of 3 months during which he underwent six piercings in different parts of his body, performed in different piercing shops in Europe and the USA. There were no biomolecular data on HIV strains in this report. The theoretical risk is probably very low since HIV is a fragile virus. However, piercing of genitals may be a risk factor for HIV infection, according to some authors. Piercers and tattooists generally work without medical supervision, and techniques are often passed on from one piercer or tattooist to another directly. Even though they have become very common, body modifications still exist within a context of "epidemiological silence". However, they have a significant impact on public health and concern all health care professionals, ranging from general practitioners to emergency units. Regulations on body modifications are heterogeneous, especially in Europe.

People seeking cosmetic breast surgery must be aware of the risk of infection. In fact, 2.5% of prostheses result in infection. This should be taken into consideration by those facing a mastectomy and wanting to reconstruct their breasts, Didier Pittet of the University of Geneva reported at the ECCMID.

Breast implants have to be divided into two categories: augmentation and reconstruction. In all the cases some adverse effects could occur: infections, wound dehiscence, capsular contracture, implant rupture, etc. But infection rates are 10-fold higher in breast reconstruction than in aesthetic implants.

Major predisposing and risk factors include pre-existing scarring, radiation therapy, simultaneous mastectomy or lymph node dissection. The origin of infection can be a contaminated implant, contaminated saline within the implant, contamination of the saline implant (some implants need to be filled by the surgeon during the intervention), contaminated surgical environment, seeding of the implant by remote infection.

Usually infections occur during the first month after implantation (on average between 10-12 days) and cause fever, rapidly evolving pain, marked breast erythema. The only way to deal with such effects is the surgical removal of the implants.

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